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Title: Vascularized fibula transfer - current concept review
Authors: Hierner, Robert ×
Stock, W
Wood, Mb
Schweiberer, L #
Issue Date: Mar-1992
Publisher: Springer verlag
Series Title: Unfallchirurg vol:95 issue:3 pages:152-159
Abstract: The first vascularized fibula transfer was done by Ueba et al. (1983) in 1974 and has since become a standard technique for special indications in the English, French, Japanese and Chinese-world. Within the last 5 years this technique has received more and more attention in the German-speaking countries [3, 7, 26, 27, 30-34, 50]. The vascularized fibula transfer is successfully used to reconstruct segmental bone defects larger than 5 to 8 cm that are caused by trauma, tumor, pseudarthrosis or congenital defects. When used to treat osteomyelitis, the vascularized fibula transfer failed to fulfill expectations [22]. Bone defects smaller than 10 cm can also be treated by vascularized iliac crest transfer [22]. To achieve rapid healing, the following points must be followed carefully: when treating osteomyelitis, the infection must be healed - negative cultures and good granulation tissue - prior to bone transplantation. Application of systemic or local antibiotics and aggressive debridement of necrotic bone and soft tissue must be carried out until the cultures taken from the wound are negative. Soft tissue defects must be treated by soft tissue transfer in order to facilitate wound closure with well-vascularized tissue. Vascularized bone transfer should be the treatment of choice for the femur and upper extremities. Precise preoperative planning, especially in high-energy trauma cases, reduces the complication rate. Rigid internal fixation of the bone graft with the recipient site by a smaller proximal and distal plate or by a plate bridging the whole bone defect running parallel to the fibula graft leads to rapid healing without malalignment. An additional cancellous bone graft at both junction sites leads to significantly faster graft consolidation, especially in cases were the graft recipient site junction is in the cortical part of the diaphysis. Because of more rapid fracture healing, early mobilization may be started relatively soon. The vascularized fibula graft must be protected against stress fractures, which usually appear within the first 8 postoperative months and are often not clinically apparent with crutches and orthesis. Mechanical loading should be progressively increased after the 3rd to 6th postoperative months (time of graft healing), depending on the actual X-ray appearance. The patient should proceed with ground contact without weight bearing, partial weight bearing to full weight bearing with and finally without orthosis. The orthosis should be remouved when the graft shows sufficient hypertrophy, which is usually after 12-18 months. Complications in fracture healing or fractures of the vascularized fibula graft may occur in 25% of patients and are amenable to standard management. Experimental and clinical modifications [34] of the vascularized fibula graft and/or combinations with conventional cancellous bone grafting [2, 3, 50], vascularized periosteum transfer [32] or non-vascularized allografts [46] should increase the success rate in the future. Experimental [1, 35, 371 and clinical studies [8, 12, 28, 31, 35, 40-47] are proving the superiority of the vascularized fibula graft compared with a nonvascularized fibula graft. Because of the stable methods of internal and external fixation the support function of a cortical graft is no longer needed as much as in the past.
ISSN: 0177-5537
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Plastic, Reconstructive and Estetic Surgery Section (-)
× corresponding author
# (joint) last author

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